缩小印度营养差距：金色芥末在战斗中的作用 维生素A缺乏症Closing India’s Nutrition Gap: The Role of Golden Mustard in Fighting V

人类需要维生素A来完成诸如生长，视力和对传染病的抵抗等基本过程。维生素A缺乏症（VAD）是由于长期摄入不足以及生理需求旺盛期引起的，例如在儿童期生长骤增，怀孕和哺乳期，或者在感染期间增加了利用率（Sommer and West 1996）。因此，幼儿以及孕妇和哺乳期妇女处于最大的风险中，并且是最常见的受害者。它主要发生在食物选择有限的人群中，特别是在那些以低营养主食为主要饮食的穷国中，这些国家的社会经济地位较低（Sommer and West 1996）。 VAD是导致失明和死亡的重要原因。它还具有经济意义。改善人的营养状况可以使一生的收入至少增加10％。总体而言，人口的营养状况可以使一个国家的国内生产总值（GDP）减少2％至3％。相反，由于维生素A，铁和碘的摄入不足，每年约损失南亚国民生产总值的5％（世界银行，2005年）。 食物中的维生素A可作为肉类，乳制品和母乳等动物性食物中的视黄醇或许多水果和蔬菜中的类胡萝卜素获得。它通过动物而不是植物性食物更有效地在体内吸收（IOM 2000）。尽管吸收量会有所不同，但取决于人的现有商店，食物的制备方法和其他因素，依靠蔬菜和水果摄入维生素A的人可能无法通过正常食物摄入获得足够的维生素A。妇女，特别是5岁以下的儿童一直是全世界改善维生素A状况的工作重点，其中包括定期高剂量补充，常用食用食物的维生素A强化以及其他基于食物的方法，例如营养教育和家庭园艺计划。这些努力在任何国家都难以实施，但在印度的影响却非常有限。在印度，补充计划面临着独特的挑战，与免疫计划覆盖率低以及科学界和政府中许多人对VAD的公共卫生重要性缺乏认识有关。由于数量众多，设防取得的成功有限 小型食品生产商和监管体系不够强大，无法执行设防规则。在以多种多样的农业条件和饮食方式为背景的国家，其他以食物为基础的方法并未取得重大进展。 由于这些限制，可能需要采用新方法来减少印度的VAD。近年来，孟山都公司和能源与资源研究所开发了创新的方法，其中涉及基因重组技术以使芥菜生物强化，芥菜是印度北部许多州（VAD流行率很高的州）常用的烹饪和酸洗油的来源，它的维生素A含量。与用于开发生物强化或“黄金”大米的技术一样，这项技术可以比传统的强化方法在更大程度上强化芥末。 该出版物开始回答有关进一步开发该技术的可行性的一些问题。我们关注于芥菜的生产和消费方式是否表明芥菜油作为增加低收入儿童以及孕妇和哺乳期妇女目标人群维生素A摄入量的媒介的适当性。此外，我们提出了与高剂量补充和传统食品强化相比，生物强化芥末的成本效益分析结果。

Humans need vitamin A for such essential processes as growth, vision, and resistance to infectious disease. Vitamin A deficiency (VAD) arises from prolonged inadequate intake combined with periods of higher physiological demand, such as during childhood growth spurts, pregnancy, and lactation, or through increased utilization during infection (Sommer and West 1996). Thus, young children and pregnant and lactating women are at greatest risk and are the most common victims. It occurs primarily among people with limited food choices, particularly those in the lower socioeconomic strata of poor countries with diets predominated by less nutritious staple foods (Sommer and West 1996).

VAD is a significant cause of blindness and death. It also has economic implications. Improving a person’s nutritional status can result in an increase in lifetime earnings of at least 10 percent. Taken collectively, a population’s nutritional status can make a difference of 2 to 3 percent in a country’s gross domestic product. Conversely, about 5 percent of the gross national product of South Asia is lost each year because of deficiencies in the intakes of vitamin A, iron, and iodine (World Bank 2005).

Vitamin A in food is available as retinol in animal foods, such as meat, dairy products, and breast milk, or as carotenoids, present in many fruits and vegetables. It is much more efficiently absorbed in the body through animal rather than plant foods (IOM 2000). Although absorption varies, depending on a person’s existing stores, the method of food preparation, and other factors, people who rely on vegetables and fruits for their vitamin A intake may not get sufficient amounts through normal food consumption.

Women and especially children under age 5 have been the focus of worldwide efforts to improve vitamin A status, including periodic high-dosage supplementation, vitamin A fortification of commonly eaten foods, and other food-based approaches, such as nutrition education and home gardening programs. These efforts, challenging to implement in any country, have had a very limited reach in India. Supplementation programs face unique challenges in the Indian context, related to poor coverage by immunization programs and the lack of recognition of the public health importance of VAD by many in the scientific community and government. Fortification has had limited success because of the large number of

small manufacturers of food and a regulatory system not strong enough to enforce fortification rules. And other food-based approaches have not made significant inroads in a country with very diverse agricultural conditions and dietary patterns.

Because of those limitations, new approaches may be needed to reduce VAD in India. In recent years, the Monsanto Company and The Energy and Resource Institute have developed innovative methods involving genetic recombinant technology to biofortify mustard, the source of a commonly used cooking and pickling oil in many states in northern India, where VAD prevalence is high, to increase its vitamin A content. This technology, like that used to develop biofortified or “golden” rice¹, can fortify mustard to a far greater extent than is possible through traditional methods of fortification.

This publication begins to answer some of the questions that arise about the feasibility of further development of this technology. We focus on whether mustard production and consumption patterns indicate the appropriateness of mustard oil as a vehicle to increase vitamin A intake in target groups of lower-income children and pregnant and lactating women. Further, we present results of our analysis of the cost-effectiveness of biofortified mustard compared with high-dosage supplementation and traditional fortification of foods.